You Can Beat Alcohol Use Disorder, Starting Now

I’m an addiction psychiatrist practicing in Florida, and for years, I have observed the low utilization of medications for alcohol use disorder (AUD).

After seeing the results of a recent nationwide survey on AUD medication use, I will do my best to advocate for its use once again.

I would be remiss not to, given the lives at risk, and the lives being lost, because of this low utilization of a proven remedy.

What the data shows

The National Substance Use and Mental Health Services survey found that among outpatient mental health facilities that offered substance use disorder (SUD) treatment, including for AUD, only 40 percent of those facilities offered AUD medications to their patients. (Proven AUD medications include naltrexone, acamprosate, and disulfiram.)

Keep in mind that the 40 percent mentioned in the survey represents the number of facilities that offered the medications. Actual use of these medications is far lower nationwide. According to a 2021 NIH report, less than 2 percent of the 14 million people living with AUD take an FDA-approved medication for it.

The barriers that are getting in the way

These barriers occur on the patient and provider sides, but they’re also structural. Here’s a quick look at some key ones.

Stigma still exists among patients: Among the people I see with addiction, including AUD, many still believe that total abstinence from all drugs is the way to go. The thinking is, medications are drugs, and drugs are not allowed, so AUD medications are not allowed. This thinking is most prevalent in older people in recovery who essentially “grew up” with the mentality that total abstinence is the only option for SUD.

It’s not always the patients who believe this. It’s their family and peers as well. For example, I recently had a patient ask me if I would call his sponsor to reassure that person that the AUD medications the patient was going to start on were legitimate and that these medications weren’t “cheating” in some way.

Providers aren’t always convinced of AUD medication efficacy—and many don’t feel equipped to prescribe them: As with the patients they treat, many providers, physicians, and nurse practitioners are also at times stuck in the old ways of thinking about addiction and addiction treatment. Some still believe that total abstinence—medications included—is the gold standard of treatment.

This thinking is more common among primary care providers, many of whom have had little training in behavioral health or addiction treatment.

That leads to a key point: My sense with most providers who oppose SUD/AUD medications is that it’s not about the stigma for them. Nor is it close-mindedness about treatment options. Rather, it’s that they don’t feel like they have the expertise to prescribe these medications, or even to treat people with SUD.

Again, many providers get minimal behavioral health training in school or afterwards, and they’re wary of treating mental health conditions like AUD with medications—safe and proven though they are.

The good news is that addiction stigma is decreasing, and medication acceptance is increasing among providers, thanks to ongoing addiction training and education efforts.

Structural barriers remain: It’s clear that more education needs to happen at every level so clinicians feel more confident about using addiction medications. This requires increased buy-in from mental health facility physicians, administrators, and directors.

A second point on structural barriers: The abovementioned National Substance Use survey found that among outpatient facilities that took insurance, the use of AUD medications was significantly higher. In other words, if insurance companies provide a way to pay for the medications, patients are more likely to get them.

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Where we go from here

We need to:

• Continue to lower the stigma around addiction, addiction treatment, and addiction medications until that stigma is gone for good.
• Train more doctors in behavioral health and addiction—starting in medical school, but also at their practices—so they’re comfortable with medications as an integral part of mental health treatment and can advocate for those medications.
• Increase access to addiction treatment and strategize on making treatment more accessible.

Final thoughts

We on the provider side need to take every opportunity to advocate for increased use of safe, effective SUD/AUD medications.

It’s 2025. We should be further along on this.

The bottom line: SUD/AUD medication is not fairy dust. We know it works, and we’ve known it works for decades. We just need to use it more.